Kidney cancer treatment

1. Renal cell carcinoma surgery are divided into simple nephrectomy and radical nephrectomy is currently accepted that radical nephrectomy can improve the survival rate. Radical nephrectomy, including perirenal fascia and its contents: perirenal fat, kidney and adrenal gland. With regard to radical nephrectomy whether to proceed with regional lymph node dissection remains controversial, and some that are often full of blood and lymph nodes metastasis, with lymph node metastasis in cases of blood metastasis eventually occurs, lymph nodes widely distributed, easily cleaned; but some people think that , lymph node metastasis mainly in the renal hilum in the vicinity; the inferior vena cava and aortic areas, can be radical resection, but the radical lymph node dissection were found to have metastases, and few survived more than 5 years. Surgical ligation of renal cell carcinoma should be fighting for the first renal artery and renal vein, can reduce blood loss and may cause hand-tumor spread. Renal cell carcinoma is a multi-vascular tumor, often a large collateral veins, surgery easy bleeding, and difficult to control. Thus, in the larger tumors, it can in the preoperative selective arterial embolization can cause severe pain, fever, intestinal paralysis, infection and should not be routinely used.

The special problems of treatment of renal cell carcinoma:

(1) to retain the kidney cancer surgery kidney: nephron-sparing surgery, such as the organization of bilateral renal cell carcinoma renal cell carcinoma or isolated kidney kidney and contralateral renal function well, such as renal vascular hypertension, kidney stones, renal tuberculosis, renal pelvis and ureter Even at stenosis. Small renal cell carcinoma that is <3cm in diameter and are located in kidney may also consider retaining the edge of the kidney surgery, surgical techniques for some of nephrectomy may also be tumor thrusts.

(2) the inferior vena cava tumor thrombus: renal cell carcinoma prone to renal vein and inferior vena cava tumor thrombus within the past few years that a failure to find local or distant spread of radical resection of renal cell carcinoma may also remove or intravenous tumor thrombus out within the inferior vena cava tumor thrombus, the prognosis remains good. The inferior vena cava occlusion during surgery should be above the level of thrombosis, fatal pulmonary embolism can be avoided. If thrombus extends to the heart, the pericardium may be within the inferior vena cava occlusion, and then cut the inferior vena cava, remove the embolus.

(3) renal cell carcinoma local spread violations of adjacent tissue and organ: This is the thorny issue of the treatment of renal cell carcinoma. Complete surgical resection of tumors and their involvement in the organization is the only cure, these patients survived five years, but 5%. Local proliferation of renal cell carcinoma may be associated with pain, because the tumor invaded after the abdominal and sacral spine muscle and nerve roots. Direct infiltration of the liver less renal cell carcinoma, intrahepatic metastasis rather than a direct invasion. Duodenum and pancreas involved almost no possible cure. Although there are distant metastasis, if the operation is possible, a majority or be able to remove the original kidney disease, transfer lesions it is possible to obtain at a long retention rule rate, after the removal of kidney disease, hematuria and pain has also been removed, is still worth it.

2. Immune therapy: over the years has proved to be human solid tumor cells within the tumor cells of their immune response, but tumor-infiltrating lymphocytes (TIL) against autologous tumor cytotoxicity tend to be lower, because tumor inhibitory mechanism of This TIL cells in vitro stimulation and expansion of the need to bring into full play of self-tumor cytotoxicity. Normal human lymphocytes and interleukin 2 (IL-2) cultured able to generate effector cells as lymphokine-activated killer cells or LAK cells. A group of LAK cells and IL-2 treatment of renal cell carcinoma in 57 cases; LAK cells + IL-236 cases of pure IL-221 Li, LAK cells + IL-2 group of complete remission (CR) 4 patients and partial remission (PR) 8 cases, there is Efficiency 12/36 (33%). IL-2 group, only l/21 cases of CR. Tumor-infiltrating lymphocytes or TIL cells can also be used in vitro IL-2 amplification, in animal experiments found that the adoptive transfer of TIL, its treatment effect is 50 times more than LAK cells ~ 100-fold, and may undermine its lung and liver of metastasis. The possibility of its clinical application is still explored.

3. Chemical Treatment: kidney cancer chemotherapy to be ineffective, single-drug treatment is worse. Some experts and Statistics 37 kinds of single-agent treatment of kidney cancer chemotherapeutic agents which the alkylating agent effective. The better efficacy of combined chemotherapy in combination: NVB + MTX + BLM + Tamoxifem testis; vincristine + doxorubicin + BCG + methyl ketone aldehyde oxygen pre-pregnancy; vinblastine + doxorubicin + Hydroxyurea + MA. In short multi-drug therapy is superior to single drug.

4. Immunotherapy and chemotherapy combination: a group of 957 cases of renal cell carcinoma recurrence in renal cell carcinoma metastasis ± application + IFN-A LPHA-2A treatment alone when the efficiency of 12%, such as combination therapy with vinblastine, there are effective 24%. In force two years were 50% likely to survive to 70%, ineffective survival 10% ~ 15%, the ideal dose of 1.8 million units of interferon subcutaneously or intramuscularly 3 times per week, 0.1mg/kg intravenous injection of vinblastine , 3 weeks time.

5. Biological gene therapy: current international best bio-genetic drugs - "hydroxy which Saarinen," the exact effect on the kidney, fresh fruit remarkable.